College Of Radiographers Research Articles

AI implementation in the UK landscape: Knowledge of AI governance, perceived challenges and opportunities, and ways forward for radiographers

IntroductionDespite the rapid increase of AI-enabled applications deployed in clinical practice, many challenges exist around AI implementation, including the clarity of governance frameworks, usability of validation of AI models, and customisation of training for radiographers. This study aimed to explore the perceptions of diagnostic and therapeutic radiographers, with existing theoretical and/or practical knowledge of AI, on issues of relevance to the field, such as AI implementation, including knowledge of AI governance and procurement, perceptions about enablers and challenges and future priorities for AI adoption. MethodsAn online survey was designed and distributed to UK-based qualified radiographers who work in medical imaging and/or radiotherapy and have some previous theoretical and/or practical knowledge of working with AI. Participants were recruited through the researchers’ professional networks on social media with support from the AI advisory group of the Society and College of Radiographers. Survey questions related to AI training/education, knowledge of AI governance frameworks, data privacy procedures, AI implementation considerations, and priorities for AI adoption. Descriptive statistics were employed to analyse the data, and chi-square tests were used to explore significant relationships between variables. ResultsIn total, 88 valid responses were received. Most radiographers (56.6 %) had not received any AI-related training. Also, although approximately 63 % of them used an evaluation framework to assess AI models’ performance before implementation, many (36.9 %) were still unsure about suitable evaluation methods. Radiographers requested clearer guidance on AI governance, ample time to implement AI in their practice safely, adequate funding, effective leadership, and targeted support from AI champions. AI training, robust governance frameworks, and patient and public involvement were seen as priorities for the successful implementation of AI by radiographers. ConclusionAI implementation is progressing within radiography, but without customised training, clearer governance, key stakeholder engagement and suitable new roles created, it will be hard to harness its benefits and minimise related risks. Implications for practiceThe results of this study highlight some of the priorities and challenges for radiographers in relation to AI adoption, namely the need for developing robust AI governance frameworks and providing optimal AI training.

Radiographer abnormality flagging systems in the UK – A preliminary updated assessment of practice

IntroductionRadiographer abnormality flagging systems have been in use in the UK for over 30 years, with the guidance of the Society and College of Radiographers indicated that the preliminary clinical evaluation (PCE), or comment, be the preferred system of choice. This study aimed to provide an updated assessment of current practice based upon a previous 2008 study. MethodsA cross-sectional online survey was disseminated via Twitter and aimed at departmental and reporting leads. It requested information on the types of flagging and reporting systems operated, scope of the systems employed, required education of participants, and the role of audit. ResultsResponses were received from 31 Trusts within the UK. Red dot systems were employed in 90% (n = 28) of sites, with 26% (n = 8) undertaking PCE. Skeletal radiographs were most commonly reviewed (90%; n = 28) followed by chest (58%; n = 18) and abdomen (32%; n = 10). Only 13% (n = 4) sites indicated if the image was normal but 71% (n = 22) allowed the radiographer to indicate if they were unsure. There was marked variation in the educational requirements and use of audit. ConclusionCompared to 2008 there appears to be quite minimal change in practices in the UK. There does appear to be some increase in the use of flagging systems generally and a higher proportion of PCE systems in comparison to red dot but the use of education and audit does not necessarily show much development in the past 15 years. Implications for practiceSignificant conclusions cannot be drawn due to limited sample size, however, it may support further study and consideration in relation to implementation and potentially standardisation of abnormality detection systems may be justified.

Current pressure on the UK imaging workforce deters imaging research in the NHS and requires urgent attention

Medical imaging is a multidisciplinary specialty, combining clinical expertise from medical physics, radiography, and radiology, and plays a key role in patient care. Research is vital to ensure the care delivered to patients is evidence-based, and is a core component of clinical governance; however, there are pressures on the imaging workforce, which are significantly impeding imaging research. This commentary presents a research gap analysis pertaining to the multidisciplinary imaging workforce on behalf of the National Institute for Health Research (NIHR) Imaging Workforce Group. Data were summarised from membership surveys of the Royal College of Radiologists, Society and College of Radiographers, and Institute of Physics and Engineering in Medicine; national reports; and feedback from NIHR Clinical Research Network Imaging Champions meeting in 2020/2021. Common barriers to delivering research were found across the multidisciplinary workforce. The key issues were lack of staff, lack of time, and lack of funding to backfill clinical services. Given the ongoing workforce shortages and increasing clinical demands on radiologists, diagnostic radiographers, and medical physicists, these issues must be tackled with a high priority to ensure the future of clinical research within the NHS.

652 Quality of Ultrasound Report in Patients with Biliary Symptoms in the Context of Surgical Diseases

Abstract Aim The diagnosis of surgical pathology in patients presenting with biliary symptoms is highly reliant on a good quality ultrasound report, our aim was to identify if there are any deficiencies in reports of ultrasound which are important diagnostic parameters of upper GI abnormalities. Method Patients presenting to Bedford hospital with biliary symptoms who require an ultrasound of biliary diseases were included, 8 parameters from the guidelines of Society and College of Radiographers were taken and analysed, means of missing data was calculated, CBD diameter was considered as a significant parameter. Quality of report for CBD was further scrutinized with patients who required 2nd investigations like MRCP and CTAP using crosstabs. Results A total of 278 patients were included in the study, 97.9% were due to gallstone diseases and 2.1% were for post-cholecystectomy. 89.7% had mentioned the normality of CBD while only 21.1% mentioned the actual value of CBD. 93% reports mentioned flow of portal vein, 7% did not mention portal vein flow. Interestingly 2.1% of ultrasounds were for post cholecystectomy but during scans, 4.6% of patients had absent gallbladder. 98 (34.5%) patients had one or more secondary investigations. 22.9% of normally reported CBD on ultrasound had positive CBD findings on MRCP. Conclusions This audit demonstrates the importance of a good quality ultrasound report. A good quality ultrasound can aid in clinical diagnosis and guidance of further investigations. Important factors to consider are the value of CBD Diameter, portal vein flow and quality of biliary stone/sludge.

The Impact of COVID-19 on the Clinical Experience and Training of Undergraduate Student Radiographers internationally: The Clinical Tutors’ perspective

IntroductionThe impact on the clinical training and education of healthcare students by COVID-19 has been documented. However, the thoughts and experiences of clinical tutors (CTs) about radiography students attending for clinical training and education during this now elongated period beyond first recognition of the virus has not been explored. This paper will discuss data collected from CTs in the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) who were compared because of their similarities in delivery based on individual ‘rules of engagement’ devised by their various health departments. AimThe purpose of this study was to examine the clinical tutors' thoughts and experiences of supervising radiography students attending clinical placement during the COVID-19 pandemic. MethodsThe UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) were selected for comparison on an international level as they are geographically distinct with a comparable population and education accredited/acknowledged by the Society and College of Radiographers (SCoR). Data was collected data from CTs across the UKDN and the UAE. The study used an online questionnaire (Google Forms) with closed questions in four themes including: students' experiences, impact on students' clinical placement, attitude of the clinical staff and the potential effects of COVID-19 on future graduates’ skills and competencies. Further data was gathered on the experience of CTs mentoring students during the COVID-19 pandemic. ResultsData were collected from 59 CTs (81%, n = 48) from UKDN and (19%, n = 11) UAE. Twenty-seven (46%) respondents reported that COVID-19 had a negative impact on clinical practical experience. However, 32 (54%) identified that COVID-19 had no impact on student supervision/feedback or on clinical achievements. Eleven (19%) respondents thought that students should not have been on clinical placement during the pandemic but a further 51% (n = 30) were happy with the students on placement and expressed willingness to delegate work to students. Interestingly, 58% (n = 34) of CTs suggested that future graduates may need a longer preceptorship after they graduate due to receiving decreased clinical experience during the pandemic. Overall, 78% (n = 46) of respondents thought that students improved their clinical confidence by working directly with COVID-19 positive patients. ConclusionThe current study has identified conflicting opinions across CTs in different clinical departments. Whilst some felt that students should not be in the hospital during the pandemic, others reported that working directly with COVID-19 patients had a positive impact on students as it improved their clinical confidence. Despite the challenges presented by COVID-19, CTs were able to provide direct clinical supervision and feedback to students on clinical placement throughout the pandemic. Nevertheless, future graduates may need a longer preceptorship period due to decreased clinical experience during the pandemic. Implications for practiceClinical placements should continue during subsequent COVID-19 waves of infection or future pandemics to ensure development of skills in resilience and adaptability. Underdeveloped skills due to a decreased range of examinations can be rectified when any wave of the infection subsides by providing tailored training based on individual student's needs.

WE2.9 Quality of ultrasound report in patients with biliary symptoms in the context of surgical diseases

Abstract Aim The diagnosis of surgical pathology in patients presenting with biliary symptoms is highly reliant on a good quality ultrasound report, our aim was to identify if there are any deficiencies in reports of ultrasound which are important diagnostic parameters of upper GI abnormalities. Methods Patients presenting to our hospital with biliary symptoms who require an ultrasound of biliary diseases were included, 8 parameters from the guidelines of Society and College of Radiographers were taken and analysed, means of missing data was calculated, CBD diameter was considered as a significant parameter. Quality of report for CBD was further scrutinized with patients who required 2nd investigations like MRCP and CTAP using crosstabs. Results A total of 278 patients were included in the study, 97.9% were due to gallstone diseases and 2.1% were for post-cholecystectomy. 89.7% had mentioned the normality of CBD while only 21.1% mentioned the actual value of CBD. 93% reports mentioned flow of portal vein, 7% did not mention portal vein flow. Interestingly 2.1% of ultrasounds were for post cholecystectomy but during scans, 4.6% of patients had absent gallbladder. 98 (34.5%) patients had one or more secondary investigations. 22.9% of normally reported CBD on ultrasound had positive CBD findings on MRCP. Conclusions This audit demonstrates the importance of a good quality ultrasound report. A good quality ultrasound can aid in clinical diagnosis and guidance of further investigations. Important factors to consider are the value of CBD Diameter, portal vein flow and quality of biliary stone/sludge.

Comparison of clinical practice guidelines on radiation dermatitis: a narrative review.

Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC). Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines. Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT. Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.

Accuracy of radiographer preliminary clinical evaluation of skeletal trauma radiographs, in clinical practice at a district general hospital

IntroductionError in interpretation of trauma radiographs by referrers is a problem which has detrimental effects on the patient and causes unnecessary repeat attendances. Radiographers can reduce errors by offering their opinion at the time of imaging. The Society and College of Radiographers have a longstanding recommendation that Red Dot (RD) schemes should be replaced by Preliminary Clinical Evaluation (PCE). The purpose of the study was to evaluate radiographer interpretation of skeletal trauma radiographs in clinical practice, determine if there was any difference in ability to interpret appendicular and axial studies, and evaluate appropriateness of PCE implementation. MethodsA convenience sample of 23 self-selecting radiographers provided RD and PCE on 762 examinations. Each case was compared against the verified report and assigned a true negative/positive or false negative/positive value. Accuracy, sensitivity and specificity were calculated and performance measures between RD versus PCE, and appendicular versus axial were compared using Two-sample Z-Tests. Error analysis was performed and inter-observer consistency determined. ResultsOverall RD and PCE accuracy, sensitivity and specificity for the study were 90%, 72% and 97% (RD), and 92%, 80% and 97% (PCE) respectively. Significant difference was demonstrated for sensitivity with PCE more sensitive than RD (p-value 0.03) and appendicular more sensitive than axial (RD p-value <0.02, PCE p-value <0.0001). Most errors were false negatives. Inter-observer consistency was evaluated by review of 128 cases and no difference between reviewers was established. ConclusionRadiographers without specific training were able to provide RD and PCE to a high standard. Radiographers interpreted positive findings more accurately using PCE than RD, and positive findings on appendicular cases were interpreted more accurately than those on axial cases. Implications for practiceThis study supports local PCE implementation, contributes to the wider evidence base to justify transition towards PCE and identifies the necessity for local axial image interpretation training.

The College of Radiographers Research Strategy for the next five years

This article outlines the updated College of Radiographers (CoR) Research Strategy. This new research strategy will shape the approach to research from the radiography profession over the next five years. This will apply to all the profession and is aspirational and future thinking.The updated research strategy is the fifth research strategy presented by the CoR. Over the last five years, there have been considerable developments within healthcare and healthcare research. As this article is being written we are still in the middle of a global pandemic (Covid-19) which has influenced all our lives. However, despite the challenges of the last year, we are in a stronger position as a profession with more radiographers working towards and gaining masters and doctoral level qualifications. There are more radiographers working in clinical academic roles and there has been further development of radiographers coordinating and delivering research as well as becoming research leaders.This updated research strategy supports the radiography profession in delivering research-based practice over the next five years offering a framework within which radiographers can develop.

International Radiographers in Danger: A Letter to the Editor

I have published a case study about how British universities −who offer radiographic reporting programs for radiographers− put admission conditions and tuitions on radiographers in three categories which are; British citizens, European citizens, and internationals [1]. I compared the three categories by collecting the data from the universities’ websites directly. The case study has a simple methodology which is clearly explained in the paper [1]. The case study showed that there is no English language requirements for Europeans due to the Bologna Agreement in June 19, 1999 and the Copenhagen Declaration in November 2002. The English language is not the mother tongue of any European country besides the UK. The tuitions for international students are very high compared to the UK/European citizens where they (UK/European) have the same low tuition. In addition, the international students can’t join approved programs from the HCPC, while UK/European citizens can join HCPC approved programs. The interpretation modules are not allowed for international students and they are allowed for UK/ European students. Training, ability to have the HCPC registration, and the ability to work all are allowed for UK/European citizens, while international students are not allowed to do so. After I published this case study which shows the facts in solid data that there is segregation on all levels and discrimination against international Radiographers, the Society and College of Radiographers and the Head of Radiography Education sent two letters threatening the journals Editors and I [2,3]. They said they are so perfect and they do not have any discrimination whatsoever [2,3]. They demanded to remove the paper from the online source and publish an apology [2,3]. They threaten and bullied me and the journal editors that they will legally be suing us for defamation. Therefore, I publish this letter challenging them to sue me. What I have published is accurate 100% and I did not make the numbers from my head. I collected the data from the universities’ websites directly. All that they claimed in their letters are wrong and emotionally driven. They did not stop here, no they continued by sending their trolls to report my researchgate account to suspend my account for more than one month. Is well known that the HCPC and the British media when someone is not British get suspended or not allowed to do any medical practice in the UK for any issue, the British media and HCPC publish their names, age, gender, ethnicity, nationality, and what mistake they did, but when the person is a white British citizen, the HCPC and the media tend to hide their identity and usually they get suspended for a short period of time. The HCPC, Society of Radiographers, and Heads of Radiography Education are discriminating on all levels against us as international radiographers and this is supported by numbers and solid data. They claim that they are so perfect and do not have any issue. This level of denial indicates that there is a massive issue and this is only the tip of the iceberg. The Society of Radiographers did not help the UK or international Radiographers in any way, shape, or form. Instead of denying their discriminatory behaviors against us, they should help the international Radiographers to rebuild their health care sector which collapsed after the pandemic (i.e. SARS II CoV a.k.a Covid-19). They have already a large shortage of Radiographers in the UK and with these behaviors, they will never solve the problems which the British citizens face every day in UK hospitals. No one should forget the number of international health care workers who sacrificed their lives during the pandemic to help the patients in the UK.

An analysis of advanced and specialist posts in diagnostic radiography: Do job descriptions describe advanced practice?

IntroductionUnderpinned by a multi professional advanced clinical practice (ACP) framework, role consistency in practice level and education has been advocated across allied health professions. However little research has evaluated ACP expectations in radiography. This study identified the capability requirements of advanced and specialist diagnostic radiographers and mapped these to home country advanced practice frameworks and the Society and College of Radiographers (SCoR) Education and Career Framework. MethodsA consecutive sample of UK job advertisements was collected over six months and analysed for role focus, professional and clinical responsibilities, reporting or procedural expectations and knowledge and experience. Qualitative content analysis was used to scrutinise capabilities during role mapping. ResultsA total of 42 job descriptions were analysed across UK Trusts and Health Boards, with 31 roles (73.8%) containing the terms advanced or specialist. Half of the advertised roles expected proficiency in reporting (n = 21; 50%). Responsibilities mapped to the practice outcomes of the SCoR framework in 31 roles (n = 31/42; 73.8%). The English documents (n = 40/42; 95.2%) evaluated against the multi professional framework identified significantly (χ2 = 14.6; p < 0.01) fewer capabilities (n = 13/40; 32.5%). Clinical practice was reflected broadly in textual behavioural descriptors however, leadership, education and research responsibilities were internal and operational in nature. ConclusionThis analysis of diagnostic radiographer job descriptions has demonstrated that many posts advertised as ‘advanced’ differ from advanced practice roles defined by the multi professional ACP framework, although they meet professional body standards. Implications for practiceUtilisation of diagnostic radiographers as ‘true’ advanced clinical practitioners remains intermittent. Greater consistency in job descriptions is required to strengthen radiography advanced practice and support radiographer development.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.

IAFR Guidelines for best practice: Principles for radiographers and imaging practitioners providing forensic imaging services

• IAFR guidelines for radiographers, managers or planners • Provision of forensic imaging services Radiography for forensic purposes is a complex area of practice and the International Association of Forensic Radiographers (IAFR) is pleased to provide this guidance and advice document for Radiographers and Radiological Technologists involved in providing forensic imaging services. These guidelines were originally published as a collaboration between the IAFR and the College of Radiographers in the United Kingdom (UK), in 1998 [1] . As membership of the IAFR continues to grow internationally, these guidelines have now been updated to be more applicable outside the UK justice system [2] . The aim is that the principles outlined in these international 'best-practice' guidelines will be adapted by national professional bodies and relevant health and justice departments to suit local medico-legal systems within each country, and that departmental managers and employers should also find this document invaluable [3] . It is recognised that the level of best practice that can be achieved is dependent on local facilities and resources, as well as the expertise of the radiographer(s).

Utilising barcode scanning to reduce the number of incidents of forgotten bolus

Keywords: quality improvement; barcode; bolus; radiotherapy errors; safety Introduction: Since departmental change from paper to electronic patient positioning instructions, there has been a sharp increase in instances whereby bolus has been incorrectly omitted for any partial or whole treatment. These events are classified as minor radiation incidents as per the Towards Safer Radiotherapy guidelines(1). Data on these incidents is reported through Datix. Available data shows a total of 42 errors. The records extend to December 2007, with the first recorded incident in April 2009. Between December 2007 and October 2016 there were 18 incidents. Between November 2016 and the inception of this project in May 2018 there were 18 incidents. This quality improvement project seeks to utilise treatment inhibits and barcode scanning to reduce these incidents to zero. Method and Materials: A paperless workflow, utilising a custom report within MOSAIQ® (Elekta AB, Sweden), was designed for the generation of treatment field specific barcodes. These were stored individually in the patient chart and displayed in the specific field. After initial testing of a single barcode scanner, they were installed across the entire fleet of 12 linear accelerators. After in-depth end-to-end testing the process was deemed suitable for implementation and a “go live” date decided upon. A number of volunteers aided with generating barcodes for all current patients. Protocols were uploaded to the local quality management system and training delivered to staff. Results: Since inception of the project a further six errors were reported. The process went live on the 6th June 2019 for all patients with bolus. Error reports have been robustly checked since implementation. No incidents have since been reported. Conclusion and Discussion: Since implementation on the 6th June 2019 there have been no reported instances of bolus being incorrectly omitted for any patient treatments. The utilisation of the barcode scanners appears to have reduced the number of associated incidents. Results will be updated further at time of presentation. Numerical References (1) The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine, National Patient Safety Agency, British Institute of Radiology. Towards Safer Radiotherapy. RCR; 2008.

Departmental practice on informed consent in radiotherapy: results from a UK evaluation

Keywords: Consent, Education, Capacity, Radiotherapy Introduction: Valid and informed consent is fundamental in health care. Professional bodies, including The Society and College of Radiographers (SCoR)1, have updated consent guidance post-Montgomery2. Radiotherapy treatment involves potential risks and side effects therefore obtaining written consent is advised3. SCoR have recognised that therapeutic radiographer (TR) training should be available to support the increasing number of patients considered to lack capacity4. With limited research on consent processes and education to support informed consent for those who lack capacity, a questionnaire was distributed to UK radiotherapy centres to establish current practices for consent and evaluate educational needs of TRs. Methods & Materials: Ethical approval was granted and an electronic questionnaire distributed to the heads of radiotherapy, UK. The questionnaire comprised of three sections: departmental practice for consent to procedures, consent of patients who lack capacity, and radiographer education. A combination of open and closed questions were asked. Free-text answers were analysed and themes established. Results: Thirty-nine departments (51%) completed the survey; all departments obtain written consent before radiotherapy treatment. One department reported not having a consent policy, however half had updated their policy since January 2018. Thirty-six departments (92%) have a separate consent form for patients who lack capacity. Reported practice included patients’ representatives signing standard consent forms in five departments (13%) and one department (3%) reported the patient who lacked capacity signing their own consent form. Therapeutic radiographers attended consent training in twenty departments (51%), 13 departments included capacity training. Frequency was wide-ranging between annual training to on appointment only. Conclusion and Discussion: This is the first UK study to evaluate consent processes for individuals who lack capacity and TR education in consent. Many departments follow guidance, utilising separate consent forms for individuals who lack capacity. Departments who have representatives’ or patients’ sign consent forms are recommended to review their policies to support best practice guidance; ensuring consent processes are effective and in the best interest of patient's. It is important that all TR are familiar with the ethical and legal issues surrounding consent and departments should consider this in their education and training framework. Numerical

Category – Imaging

Introduction Ultrasound is considered as the first‐line imaging method of choice in gynaecology due to it being a simple, accurate, and safe technique. The quality and diagnostic accuracy of ultrasound depends on the skills of the individual performing the ultrasound scan. Despite the implications that poor ultrasound practice has on patient safety, the role of training and evaluation of ultrasound practice has received limited attention. Aim Ultrasound practice in a general gynaecology clinic was assessed by evaluating the video‐recorded quality of ultrasound images and comparing these to best practice guidelines; Objective Structured Assessment of Ultrasound Skills (OSAUS), Society and College of Radiographers, British Medical Ultrasound Society (SCoR/BMUS), and International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG). Methods A video recording device was connected to a randomly selected ultrasound machine in gynaecology clinics of a busy teaching hospital. To minimise the Hawthorne effect, staff were notified through email 3 weeks in advance. Data were collected over a three‐week period. The anonymised recordings were analysed against current best practice guidelines. Ultrasound practice was categorised as compliant, partially compliant and noncompliant. Results In total, 43 observations of ultrasound use were recorded and findings with regard to the three categories were recorded as percentage frequencies (%). The study found 41.9% of images were annotated appropriately and 25.6% of clinicians examined bladder, vagina, and cervix when indicated. Assessment of image optimisation was compliant in 23.3% of recorded observations, 11.6% partially compliant, and 65.1% noncompliant. The study also found that the global examination on gynaecology was 20.9% compliant, 18.6% partially compliant, and 60.47% noncompliant. Conclusion The study has shown that ultrasound practice among gynaecologists did not reflect the standards of current guidelines. The results suggest a need for improvement, through supervised training and core knobology. Accuracy and performance of ultrasound examination remains highly operator‐dependent. Video surveillance of ultrasound use was found to be an effective tool for assessing competence and performance of ultrasound examination.

An investigation into the perceived value of the College of Radiographers voluntary accreditation scheme for advanced and consultant practitioners in breast imaging

IntroductionA voluntary accreditation scheme has been introduced, requiring advanced (AdP) and consultant practitioners (CP) to submit several pieces of work to the College of Radiographers (CoR). However, few individuals have opted to become voluntary accredited. This study investigated the reasons behind becoming voluntary accredited, the value that was gained and why there appears to be a lack of support for the scheme. MethodsAn online electronic survey was conducted using a mixed methods approach. Open questions enabled individual opinions and thoughts to be expressed, Likert scale style questions allowed further understanding of the level of agreement and closed questions identified the support for and against the scheme. ResultsA total of 55 respondents participated, including 18 AdPs, 25 CPs, 1 consultant trainee practitioner, 5 practitioners and 6 listed as ‘other’. Forty-four participants were non-accredited, citing too much clinical work; no recognition from employers and too much effort for little reward. Motivations for joining the scheme were to improve the profession; help create a new consultant post and protect the non-clinical element of the consultant role. ConclusionThe CoR voluntary accreditation scheme has a small perceived value but overall, the majority of respondents believed the scheme did not warrant the work needed to apply. Concern was raised about the risk of creating a two-tier profession by the scheme's instigation. The results of this study suggest that the CoR's voluntary accreditation scheme would need to address these barriers before more practitioners would apply.

A Canadian Survey of the Management of Radiation-Induced Skin Reactions

IntroductionRadiation therapy skin reactions are one of the most common side effects and can cause patient distress. In some cases, a severe radiation-induced skin reaction may limit delivered dose and potentially compromise treatment outcomes. There are some established best practices, but approaches and patient advice appear to have changed little over the years and are often based on tradition, not evidence. Canadian radiation therapy departments use different skin care products and approaches, and there has been little previous work to examine national practice patterns. Materials and MethodsThis study used a 42-item electronic survey based on a questionnaire designed by the UK Society and College of Radiographers. Practice data were collected related to assessment and prophylactics, interventions for prevention and management, and use of tools and guidelines. The final survey version was distributed to an identified radiation therapist-registered nurse dyad at each radiation therapy department in Canada (n = 44). ResultsThirty-three departments responded (75% response rate). Results suggest a variation in national management. A number of departments continue to advise patients not to wash or use deodorant/antiperspirant despite having evidence to the contrary. There are also unnecessary restrictions on the use and timing of application of lotions as well as conflicting postradiotherapy skin care instructions regarding sun exposure. ConclusionThe study demonstrated variation in practice across Canadian radiation therapy departments. National interprofessional guidelines could improve uptake of best practices. Where there is little evidence, a stress-reduction approach with more collaborative decision-making should be used to minimize patient disruption.

Improving GP access to U/S – a multidimensional approach in collaboration with the Primary Care Division

Improving GP access to U/S – a multidimensional approach in collaboration with the Primary Care Division

The feasibility of implementation of ultrasound equipment standards set by United Kingdom professional bodies

The Royal College of Radiologists and the Society and College of Radiographers in the United Kingdom published 'Standards for the provision of an ultrasound service', including application-specific limiting values for resolution and penetration. No measurement methods were detailed. We aimed to explore a possible theoretical basis for the standards and to develop a measurement protocol. Since application-specific standards fail to account for probes of different frequencies used for similar applications and no evidence for the standards was provided, we developed generic standards based on theoretical considerations. In a trial implementation of the published standards, automated measurements were made on four recently purchased scanners with a total of eight probes, results being assessed against the standards. Measurements were made on 15 modern probes and used to develop our generic standards. Automated measurements showed less inter- and intra-observer variability than manual/visual measurements. Four new ultrasound scanners with a total of eight probes all failed to meet the published axial and lateral resolution standards; three failed to meet the penetration standard. Our generic standards were tested on 15 probes, four probes failing to meet the revised standards. Automated methods are essential for measurements against standards. New generic standards with a theoretical basis have been proposed. Further work is required to refine standards and methods and to determine the appropriate contributions of objective and subjective equipment selection methods.